The Immunization of School Pupils Act (ISPA) is the Ontario legislation that outlines the responsibilities of Ontario public health units to maintain immunization records for students attending schools in their jurisdictions, and to assess those records to ensure that students are appropriately immunized against designated vaccine-preventable diseases of public health significance. Under the ISPA, students whose immunization records are not up-to-date for designated diseases may be suspended from school. Those who have had the disease of interest or who have medical reasons for being unimmunized against ISPA-designated diseases can submit a Statement of Medical Exemption. Those who have philosophical or religious reasons for being unimmunized can submit a Statement of Conscience or Religious Belief.